Home' Community Care Review : CCR Nov-Dec 2015 Contents Consumer Directed Care (CDC) & National Disability
Insurance Scheme (NDIS)
Independence... Wellness... Choice... Decision... Control...
How will you compare in the market?
Green Sea Shell Consulting offers competitive, quality,
focused solutions to the Aged Care and Disability Sector.
Advanced direction and leadership in delivering
individualised care models.
Marisa Galiazzo - Owner/Principal
Green Sea Shell Consulting
P: (02) 9808 4830 | M: 0402 097 866
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The changes in working capital that result
from being paid in arrears will also need to
be well understood and managed.
INSIGHTS FROM OVERSEAS
The overseas experience provides some
interesting insights into how the "cash for
care" approach might evolve in Australia. In
the UK, where direct payments for aged care
and disability services via individualised
client budgets were introduced in 2005-2006,
there has been a major increase in both
utilisation and spending over time. The UK's
Health and Social Care Information Centre
reported costs of direct payments have risen
to £1.4 billion in 2013-2014 (8 per cent of
total spending) -- a 103 per cent increase in
real terms since 2008-2009, when the cost
of direct payments was £680 million (4 per
cent of total expenditure). In terms of uptake,
the number of people receiving self-directed
support has increased to 62 per cent of
clients in 2013-2014, compared to 28 per cent
in 2010-11. The early Australian experience
of implementing consumer directed care
for home care packages is that initially a
relatively small proportion of clients (15-20
per cent) are opting to manage their own
services, but this will increase over time.
Getting to the facts in terms of outcomes
of these reforms can be difficult. In 2011,
the UK academic Jason Powell said: "the
evidence base in relation to the critical
success factors of personalisation is
extremely scarce". Volumes have been
written on the policy context and strategic
purpose for the reforms, but there is much
less research on the impacts and outcomes.
The 2008 UK evaluation report on the
pilot of individualised budgets includes
an interesting analysis which compared
a group of 504 people managing their
own services via an individual budget
to a group of 439 people supported by
traditional service models. In terms of
quality of life, wellbeing and met needs,
the outcomes were very similar for both
groups. For older people and people
with mental illness the costs of care were
also almost identical in both groups.
The weekly costs of care for people using
individual budgets were slightly lower
for people with learning difficulties and
physical disabilities. Interestingly, the
cost of care management was higher for
people using individual budgets, £18
per week compared to £11 per week for
There are some cautionary lessons
from the overseas experience. Research
indicates that older people are likely to
experience fewer benefits from self-directed
care. The author of a recent study from
Coventry University, Dr John Woolham,
reported: "People like the idea of personal
budgets, but having the cash to spend
directly doesn't always give people more
control -- and we think many older people
may be less interested in choice than in
reliability and continuity of care." Provision
of services via personal budgets did not
always improve the outcomes for clients
in terms of aligning the timing of services
with individual preferences, or providing
continuity of caregivers. Some older
clients and carers find that the process of
arranging and managing services can be
stressful and burdensome.
The lessons for Australia are that these
changes are likely to have a profound
impact on the provider market as increasing
numbers of people choose to direct their
own care and new financial arrangements
come into play.
Some key observations:
• Consolidation of some existing
providers, exits from the market and
the introduction of new providers
• There is a critical need for providers
to understand their clients' needs and
preferences, engage effectively with
them over the journey and have the
flexibility and technology to deliver
• Services must be cost effective and have
low overheads -- a major change for
• Providers need to have the capability to
demonstrate benefits by measuring and
monitoring the outcomes of services. n
Michael Roberts is a senior health
advisor with Grant Thornton.
In the new "cash-
for-care" retail market,
overheads need to be
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